Common use of Budget Neutrality Expenditure Cap Clause in Contracts

Budget Neutrality Expenditure Cap. The following describes the method for calculating the budget neutrality expenditure cap for the Demonstration: a) For each year of the budget neutrality agreement an annual budget neutrality expenditure cap is calculated for each EG described in STC 63 as follows: i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the state under STC 55 for each EG, times the appropriate estimated per member per month (PM/PM) costs from the table in subparagraph (ii) below. ii. The PM/PM costs for the calculation of the annual budget neutrality expenditure cap for the eligibility groups subject to the budget neutrality agreement under this Demonstration are specified below. For the extension period, the PMPM cost for each EG in Demonstration year 5 outlined below has been increased by the trend rates that were approved for the initial five-year demonstration period, since those trend rates are lower than those included in the President’s federal fiscal year 2011 budget. Eligibility Group DY 5 (10/1/10 - 3/31/11) Trend Rate DY 6 (4/1/11 - 3/31/12) DY 7 (4/1/12 - 3/31/13) DY 8 (4/1/13 - 3/31/14) TANF Children under age 1 through 20 $626 6.7% $667 $711 $758 TANF Adults aged 21-64 $854 6.6% $909 $967 $1,029 Disabled Adults and Children aged 0 – 64 voluntarily enrolled in managed care $2,214 6.12% $2,349 $2,493 $2,646 Disabled Adults and Children aged 0 – 64 required to enroll in managed care $2,214 6.12% $2,349 $2,493 $2,646 Aged or Disabled Elderly 65+ voluntarily enrolled in managed care $1,389 5.38% $1,464 $1,542 $1,625 Aged or Disabled Elderly 65+ required to enroll in managed care $1,389 5.38% $1,464 $1,542 $1,625 MLTC Adults aged 18 - 64 5.9% $8,379.01 $8,873.37 MLTC Adults aged 65 and above 3.6% $7,830.01 $8,111.89 iii. The annual budget neutrality expenditure cap for the Demonstration as a whole is the sum of the projected annual expenditure caps for each EG calculated in subparagraph (i) above. b) The overall budget neutrality expenditure cap for the demonstration period is the sum of the annual budget neutrality expenditure caps calculated in subparagraph (a) (iii) above for each of the demonstration years. The federal share of the overall budget neutrality expenditure cap represents the maximum amount of FFP that the state may receive for expenditures on behalf of Demonstration populations and expenditures described in STC 51 (c) during the Demonstration period.

Budget Neutrality Expenditure Cap. The following describes the method for calculating the budget neutrality expenditure cap for the Demonstration: a) For each year of the budget neutrality agreement an annual budget neutrality expenditure cap is calculated for each EG described in STC 63 paragraph 58 as follows: i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the state State under STC 55 paragraph 49 for each EG, times the appropriate estimated per member per month (PM/PM) costs from the table in subparagraph (ii) below. ii. The PM/PM costs for the calculation of the annual budget neutrality expenditure cap for the eligibility groups subject to the budget neutrality agreement under this Demonstration are specified below. For the extension period, the PMPM cost for each EG in Demonstration year 5 outlined below has been increased by the trend rates that were approved for the initial five-year demonstration period, since those trend rates are lower than those included in the President’s federal fiscal year 2011 budget. Eligibility Group Trend Rate DY 1 (10/1/06 – 9/30/07) DY 2 (10/1/07 – 9/30/08) DY 3 (10/1/08 – 9/30/09) DY 4 (10/1/09 - 9/30/10) DY 5 (10/1/10 - 3/31/11) Trend Rate DY 6 (4/1/11 - 3/31/12) DY 7 (4/1/12 - 3/31/13) DY 8 (4/1/13 - 3/31/149/30/11) TANF Children under age 1 through 20 $626 6.7% $667 482.15 $711 514.58 $758 549.19 $586.13 $625.56 TANF Adults aged 21-64 $854 6.6% $909 661.56 $967 705.21 $1,029 751.73 $801.33 $854.19 Disabled Adults and Children aged 0 – 64 voluntarily enrolled in managed care $2,214 6.12% $2,349 1,746 $2,493 1,852 $2,646 1,966 $2,086 $2,214 Disabled Adults and Children aged 0 – 64 required to enroll in managed care $2,214 6.12% $2,349 1,746 $2,493 1,852 $2,646 1,966 $2,086 $2,214 Aged or Disabled Elderly 65+ voluntarily enrolled in managed care $1,389 5.38% $1,464 1,126 $1,542 1,186 $1,625 1,250 $1,318 $1,389 Aged or Disabled Elderly 65+ required to enroll in managed care $1,389 5.38% $1,464 1,126 $1,542 1,186 $1,625 MLTC Adults aged 18 - 64 5.9% 1,250 $8,379.01 1,318 $8,873.37 MLTC Adults aged 65 and above 3.6% $7,830.01 $8,111.891,389 iii. The annual budget neutrality expenditure cap for the Demonstration as a whole is the sum of the projected annual expenditure caps for each EG calculated in subparagraph (i) above. b) The overall budget neutrality expenditure cap for the 5-year demonstration period is the sum of the annual budget neutrality expenditure caps calculated in subparagraph subparagraph (a) (iii) above for each of the demonstration 5 years. The federal Federal share of the overall budget neutrality expenditure cap represents the maximum amount of FFP that the state State may receive for expenditures on behalf of Demonstration populations and expenditures described in STC 51 paragraph 45 (ce) during the Demonstration period.

Budget Neutrality Expenditure Cap. The following describes the method for calculating the budget neutrality expenditure cap for the Demonstrationdemonstration: a) For each year of the budget neutrality agreement an annual budget neutrality expenditure cap is calculated for each EG described in STC 63 66 as follows: i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the state under STC 55 58 for each EG, times the appropriate estimated per member per month (PM/PM) costs from the table in subparagraph (ii) below. ii. The PM/PM costs for the calculation of the annual budget neutrality expenditure cap for the eligibility groups subject to the budget neutrality agreement under this Demonstration demonstration are specified below. For the extension period, the PMPM cost for each EG in Demonstration demonstration year 5 outlined below has been increased by the trend rates that were approved for the initial five-year demonstration period, since those trend rates are lower than those included in the President’s federal fiscal year 2011 budget. Eligibility Group DY 5 (10/1/10 - 3/31/11) Trend Rate DY 6 (4/1/11 - 3/31/12) DY 7 (4/1/12 - 3/31/13) DY 8 (4/1/13 - 3/31/14) TANF Children under age 1 through 20 (demonstration population 1) $626 6.7% $667 $711 $758 TANF Adults aged 21-64 21through-64 (demonstration population 2) $854 6.6% $909 $967 $1,029 Disabled Adults and Children aged 0 – 64 through64 voluntarily enrolled in managed care $2,214 6.12% $2,349 $2,493 $2,646 Disabled Adults and Children aged 0 – through 64 required to enroll in managed care (demonstration population 4) $2,214 6.12% $2,349 $2,493 $2,646 Aged or Disabled Elderly 65+ 65 and above voluntarily enrolled in managed care (demonstration population 5) $1,389 5.38% $1,464 $1,542 $1,625 Aged or Disabled Elderly 65+ 65 and above required to enroll in managed care (demonstration population 6) $1,389 5.38% $1,464 $1,542 $1,625 MLTC Adults aged 18 - through– 64 – Non-Dual (demonstration population 7) 5.9% $8,379.01 8,873.37 $8,873.37 9,396.90 MLTC Adults aged 65 and above – Non- Dual (demonstration population 8) 3.6% $7,830.01 8,111.89 $8,111.898,403.92 iii. The annual budget neutrality expenditure cap for the Demonstration demonstration as a whole is the sum of the projected annual expenditure caps for each EG calculated in subparagraph subparagraph (i) above. b) The overall budget neutrality expenditure cap for the demonstration period is the sum of the annual budget neutrality expenditure caps calculated in subparagraph (a) (iii) above for each of the demonstration years. The federal share of the overall budget neutrality expenditure cap represents the maximum amount of FFP that the state may receive for expenditures on behalf of Demonstration demonstration populations and expenditures described in STC 51 (c54(c) during the Demonstration demonstration period.

Budget Neutrality Expenditure Cap. The following describes the method for calculating the budget neutrality expenditure cap for the Demonstration: a) For each year of the budget neutrality agreement an annual budget neutrality expenditure cap is calculated for each EG described in STC 63 48 as follows: i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the state State under STC 55 40 for each EG, times the appropriate estimated per member per month (PM/PM) costs from the table in subparagraph (ii) below. ii. The PM/PM costs for the calculation of the annual budget neutrality expenditure cap for the eligibility groups subject to the budget neutrality agreement under this Demonstration are specified below. For the extension period, the PMPM cost for each EG in Demonstration year 5 outlined below has been increased by the trend rates that were approved for the initial five-year demonstration period, since those trend rates are lower than those included in the President’s federal Federal fiscal year 2011 budget. Eligibility Group DY 5 (10/1/10 - 3/31/11) Trend Rate DY 6 (4/1/11 - 3/31/12) DY 7 (4/1/12 - 3/31/13) DY 8 (4/1/13 - 3/31/14) TANF Children under age 1 through 20 $626 6.7% $667 $711 $758 TANF Adults aged 21-64 $854 6.6% $909 $967 $1,029 Disabled Adults and Children aged 0 – 64 voluntarily enrolled in managed care $2,214 6.12% $2,349 $2,493 $2,646 Disabled Adults and Children aged 0 – 64 required to enroll in managed care $2,214 6.12% $2,349 $2,493 $2,646 Aged or Disabled Elderly 65+ voluntarily enrolled in managed care $1,389 5.38% $1,464 $1,542 $1,625 Aged or Disabled Elderly 65+ required to enroll in managed care $1,389 5.38% $1,464 $1,542 $1,625 MLTC Adults aged 18 - 64 5.9% $8,379.01 $8,873.37 MLTC Adults aged 65 and above 3.6% $7,830.01 $8,111.891,625 iii. The annual budget neutrality expenditure cap for the Demonstration as a whole is the sum of the projected annual expenditure caps for each EG calculated in subparagraph (i) above. b) The overall budget neutrality expenditure cap for the demonstration period is the sum of the annual budget neutrality expenditure caps calculated in subparagraph (a) (iii) above for each of the demonstration years. The federal Federal share of the overall budget neutrality expenditure cap represents the maximum amount of FFP that the state State may receive for expenditures on behalf of Demonstration populations and expenditures described in STC 51 36 (c) during the Demonstration period.

Budget Neutrality Expenditure Cap. The following describes the method for calculating the budget neutrality expenditure cap for the Demonstrationdemonstration: a) For each year of the budget neutrality agreement an annual budget neutrality expenditure cap is calculated for each EG described in STC 63 66 as follows: i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the state under STC 55 58 for each EG, times the appropriate estimated per member per month (PM/PM) costs from the table in subparagraph (ii) below. ii. The PM/PM costs for the calculation of the annual budget neutrality expenditure cap for the eligibility groups subject to the budget neutrality agreement under this Demonstration demonstration are specified below. For the extension period, the PMPM cost for each EG in Demonstration demonstration year 5 outlined below has been increased by the trend rates that were approved for the initial five-year demonstration period, since those trend rates are lower than those included in the President’s federal fiscal year 2011 budget. Eligibility Group DY 5 (10/1/10 - 3/31/11) Trend Rate DY 6 (4/1/11 - 3/31/12) DY 7 (4/1/12 - 3/31/13) DY 8 (4/1/13 - 3/31/14) TANF Children under age 1 through 20 (demonstration population 1) $626 6.7% $667 $711 $758 TANF Adults aged 21-64 21through-64 (demonstration population 2) $854 6.6% $909 $967 $1,029 Disabled Adults and Children aged 0 – 64 through64 voluntarily enrolled in managed care $2,214 6.12% $2,349 $2,493 $2,646 Disabled Adults and Children aged 0 – through 64 required to enroll in managed care (demonstration population 4) $2,214 6.12% $2,349 $2,493 $2,646 Aged or Disabled Elderly 65+ 65 and above voluntarily enrolled in managed care (demonstration population 5) $1,389 5.38% $1,464 $1,542 $1,625 Aged or Disabled Elderly 65+ 65 and above required to enroll in managed care (demonstration population 6) $1,389 5.38% $1,464 $1,542 $1,625 MLTC Adults aged 18 - through– 64 – Non-Dual (demonstration population 7) 5.9% $8,379.01 8,873.37 $8,873.37 9,396.90 MLTC Adults aged 65 and above – Non- Dual (demonstration population 8) 3.6% $7,830.01 8,111.89 $8,111.898,403.92 iii. The annual budget neutrality expenditure cap for the Demonstration emonstration as a whole is the sum of the projected annual expenditure caps for each EG calculated in subparagraph subparagraph (i) above. b) The overall budget neutrality expenditure cap for the demonstration period is the sum of the annual budget neutrality expenditure caps calculated in subparagraph (a) (iii) above for each of the demonstration years. The federal share of the overall budget neutrality expenditure cap represents the maximum amount of FFP that the state may receive for expenditures on behalf of Demonstration demonstration populations and expenditures described in STC 51 (c54(c) during the Demonstration demonstration period.